Variation of cost among anti-malarial drugs available in Indian market

Background: There are numerous brands of antimalarial existent in the market. Expensive drugs could result in financial drain that causes reduced compliance or even non-compliance. Non-adherence to therapy could consequently cause partial treatment that leads to higher morbidity and in certain cases mortality too. Thus this evaluation was conducted to measure the cost disparity of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in Indian rupee rate was noted by using the latest edition of current index of medical specialities. The cost ratio and the percentage cost variation for individual drug brands were calculated.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Chloroquine DS 500 mg showed the highest cost ratio and cost variation (cost ratio=15.3 and % cost variation=1434). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents.Conclusions: The maximum variation shown by oral antimalarial was found to be for chloroquine DS 500 tablet. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment

Cost variation analysis of parenteral antibiotics in Indian pharmaceutical market

Background: The objective of the present study was to analyse price differences between parenteral antibiotics available in a tertiary care teaching hospital.Methods: The study was done in the Department of Pharmacology of S. D. M. College of Medical Sciences, Dharwad, Karnataka. Latest volume of current index of medical specialties or Indian Drug Review was used to analyze the prices of parenteral antibiotics.Results: Overall, prices of 17 single drug antibiotics available in 37 strengths marketed and 8 fixed-dose combinations available in 16 strength marketed were analyzed. It was observed that the maximum cost variation among the single ingredient parenteral antibiotic was with cefpirome 1000 mg. The price difference being Rs. 283 and the cost variation being 90.7%. The minimum price variation was seen with Ampicillin 100 mg of Rs. 4.3 and the cost variation being 40.2%. Additionally the highest price difference was also seen teicoplanin 400 mg i.e., Rs. 610 and its cost variation being 68.5%. Among the fixed-dose combination (FDC’s) the maximum price variation was observed in the combination of cefoperazone+sulbactum 1000+1000 of Rs. 340. Whereas the cost variation of the same was 212.5 %. The minimum price variation among the FDC’s was of the combination of ceftriaxone 250 mg + tazobactum 31.25 mg Rs. 3.3 and its cost variation being 7.9 %.Conclusions: Pharmacoeconomics facets must be taken into deliberation by healthcare practitioners while prescribing antibiotics to the patients for infectious disease treatment. This will assist compliance, reduce antibiotic resistance and treatment failure

Drug usage pattern of antimicrobials in elderly hypertensive, diabetic in-patients with or without impaired renal function

Background: Hypertension (HTN) and diabetes mellitus (DM) are the primary contributors to renovascular mortality and morbidity including chronic kidney diseases. Additionally, these patients are in frequent need of an antimicrobial agent. Drug utilisation studies (DUS) are prospective tools in the assessment of health care systems. The objective of the present study was to analyse the prescription pattern of anti-microbials in elderly hypertensive diabetic in-patients with or without renal impairment in a tertiary hospitalMethods: The study population comprised of 165 hypertensive diabetic in-patients at Shri Dharmasthala Manjunatheshwara (SDM) Hospital. Questionnaire based evaluation was carried out and prescriptions of patient with HTN and DM at and above the age of 60 years irrespective of gender were included.Results: Among anti-microbial agents, other β lactam antibacterial were the most commonly prescribed class of drugs (40.85%) which was similar in patients with impaired renal function (21.8%).Conclusions: There was a significant increase in the number of anti-microbial agents and other drugs in the patients with impaired renal function when compared to patients with normal renal function (p <0.05)

Drug usage pattern of anti-hypertensive drugs in elderly diabetic, hypertensive in-patients with or without impaired renal function in a tertiary care hospital

Background: Hypertension (HTN) and Diabetes mellitus (DM) are the leading contributors to the cardiovascular mortality and morbidity. Drug utilisation studies (DUS) are potential tools in the evaluation in health care systems. Objectives was to analyse the drug usage pattern of anti-hypertensives in elderly hypertensive diabetic in-patients in a tertiary hospital. To analyse drug usage pattern of anti-hypertensives in elderly hypertensive, diabetic in-patients with renal impairment in a tertiary hospital.Methods: The study population consisted of 165 hypertensive diabetic in-patients at Shri Dharmasthala Manjunatheshwara (SDM) Hospital. Questionnaire based study was conducted and prescriptions of patient with HTN and DM at and above the age of 60 years irrespective of gender were included.Results: Our study revealed that angiotensin receptor blockers (ARBs) were the most commonly prescribed (42.4%) class of anti-hypertensive drugs. In patients with impaired renal function also ARBs were the most common class prescribed (22.0%). Out of 35 anti-hypertensive fixed drug combinations (FDCs) prescribed the most frequent combination was combination with an ARBs (85.7%). There was a significant increase in the number of anti-hypertensive drugs prescribed in patients with impaired renal function when compared to patients without impaired renal function (p <0.05). The cost index was high, and the percentage cost variation was more than 100% in most of the anti-hypertensive drugs prescribed.Conclusions: This study shows that the most commonly prescribed anti-hypertensive drug class was ARBs in patients with and in patients without impaired renal function

Role of Peptide Backbone Conformation on Biological Activity of Chemotactic Peptides

To investigate the role of peptide backbone conformation on the biological activity of chemotactic peptides, we synthesized a unique analog of N-formyl-Met-Leu-Phe-OH incorporating the C α,α disubstituted residue, dipropylglycine (Dpg) in place of Leu. The conformation of the stereochemically constrained Dpg analog was examined in the crystalline state by x-ray diffraction and in solution using NMR, IR, and CD methods. The secretagogue activity of the peptide on human neutrophils was determined and compared with that of a stereochemically constrained, folded type II β-turn analog incorporating 1-aminocyclohexanecarboxylic acid (Ac6c) at position 2 (f-Met- Ac6c -Phe-OMe), the parent peptide (f-Met-Leu-Phe-OH) and its methyl ester derivative (f-Met-Leu-Phe-OMe). In the solid state, the Dpg analog adopts an extended β-sheet-like structure with an intramolecular hydrogen bond between the NH and CO groups of the Dpg residue, thereby forming a fully extended (C5) conformation at position 2. The ϕ and ψ values for Met and Phe residues are significantly lower than the values expected for an ideal antiparallel beta conformation causing a twist in the extended backbone both at the N and C termini. Nuclear magnetic resonance studies suggest the presence of a significant population of the peptide molecules in an extended antiparallel β conformation and the involvement of Dpg NH in a C5 intramolecular hydrogen bond in solutions of deuterated chloroform and deuterated dimethyl sulfoxide. IR studies provide evidence for the presence of an intramolecular hydrogen bond in the molecule and the antiparallel extended conformation in chloroform solution. CD spectra in methanol, trifluoroethanol, and trimethyl phosphate indicate that the Dpg peptide shows slight conformational flexibility, whereas the folded Ac6c analog is quite rigid. The extended Dpg peptide consistently shows the highest activity in human peripheral blood neutrophils, being approximately 8 and 16 times more active than the parent peptide and the folded Ac6c analog, respectively. However, the finding that all four peptides have ED50 (the molar concentration of peptide to induce half-maximal enzyme release) values in the 10(-8)-10(-9) M range suggests that an induced fit mechanism may indeed be important in this ligand-receptor interaction. Moreover, it is also possible that alterations in the backbone conformation at the tripeptide level may not significantly alter the side chain topography and/or the accessibility of key functional groups important for interaction with the receptor

Numerical and analytical investigation towards performance enhancement of a newly developed rockfall protective cable-net structure

In a previous companion paper, we presented a three-tier modelling of a particular type of rockfall protective cable-net structure (barrier), developed newly in Japan. Therein, we developed a three-dimensional, Finite Element based, nonlinear numerical model having been calibrated/back-calculated and verified with the element- and structure-level physical tests. Moreover, using a very simple, lumped-mass, single-degree-of-freedom, equivalently linear analytical model, a global-displacement-predictive correlation was devised by modifying the basic equation – obtained by combining the principles of conservation of linear momentum and energy – based on the back-analysis of the tests on the numerical model. In this paper, we use the developed models to explore the performance enhancement potential of the structure in terms of (a) the control of global displacement – possibly the major performance criterion for the proposed structure owing to a narrow space available in the targeted site, and (b) the increase in energy dissipation by the existing U-bolt-type Friction-brake Devices – which are identified to have performed weakly when integrated into the structure. A set of parametric investigations have revealed correlations to achieve the first objective in terms of the structure's mass, particularly by manipulating the wire-net's characteristics, and has additionally disclosed the effects of the impacting-block's parameters. Towards achieving the second objective, another set of parametric investigations have led to a proposal of a few innovative improvements in the constitutive behaviour (model) of the studied brake device (dissipator), in addition to an important recommendation of careful handling of the device based on the identified potential flaw

Salivary Leptin Levels in Children with Early Childhood Caries – An Interventional Study

Background: Early childhood caries (ECC) is a pathologic condition of multifactorial nature. The diagnosis of the same has been limited to clinical and radiographic aids with very little significance to assess its inflammatory component. objectives: The present study aims to evaluate the role of leptin, an adipocytokine as a non-invasive inflammatory biomarker in ECC. Materials and Method: A total of 60 children between the age of (3-5) years were selected for the study. The study subjects were divided into three groups of 20 each including Group 1 as control, Group 2 with mild to moderate ECC and Group 3 with severe ECC. Saliva samples were taken from all subjects and collected again after 2 months following rehabilitative intervention. Levels of salivary leptin were determined using Enzyme-Linked Immunosorbent Assay (ELISA). Results: Levels of salivary leptin were significantly associated with severity of dental caries. The intragroup comparisons of pre and post treatment levels of salivary leptin showed significant reductions in both mild to moderate ECC and severe ECC groups following caries control. Inter group evaluation between mild to moderate ECC and severe ECC post treatment showed statistically significant decline of leptin levels in comparison to baseline values. Conclusion: There was a statistically significant decline in salivary leptin levels between the mild moderate and severe ECC group, after 2 months following caries control. Thus, leptin holds a potential to be recognized as a reliable future prognostic and diagnostic inflammatory marker in early childhood caries

IMPROVEMENT OF THE SOLUBILITY AND DISSOLUTION OF TOLFENAMIC ACID USING LYOPHILIZATION TECHNIQUE

Abstract: The aim of the present study was to prepare freeze dried crystals (FD) of Tolfenamic acid (TA) by freeze drying technique. Crystallization medium used for freeze drying of Tolfenamic acid consisted of N,N-dimethylformamide (DMF) and Water as solvent systems. The presence of solvents residuals in FD was determined by Gas chromatography and particles were characterized by DSC, FT-IR, XRD and SEM. The respective solubility study and dissolution behaviour studies were carried out. The samples were stored in stability chamber to investigate their physical stabilities. Residual Solvents in FDs were found to be within the limit and exhibited decreased crystallinity as well solubility and dissolution of the Freeze dried crystals was improved than commercial sample of Tolfenamic acid. In stability study, it was found that physical properties and release profile of the freeze dried crystals was unaffected for 3 months. Hence this technique can be used to obtain modified drug raw material for formulation of tablets of Tolfenamic acid by direct compression with directly compressible tablet excipients

Causes of large-scale landslides in the Lesser Himalaya of central Nepal

Abstract: Geologically and tectonically active Himalayan Range is characterized by highly elevate

Awareness regarding eye donation among stakeholders in Srikakulam district in South India

Background There is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India. Methods 355 subjects were selected from the district using multi stage random sampling. A pre tested semi structured questionnaire was used to collect information regarding each individual’s awareness, knowledge, and perception regarding eye donation. Each response was scored individually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels. Results Of the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p < 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p < 0.001), female gender (p < 0.001) and education (p < 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban). Conclusions Awareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population